Individual
DR. CLIFTON SAMUEL HALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4488 S PECOS RD, LAS VEGAS, NV 89121-5030
(702) 436-1001
(909) 557-1924
Mailing address
PO BOX 894830, LOCK BOX 4830, LOS ANGELES, CA 90189-4830
(702) 853-7451
(909) 557-1924
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
14219
NV
207N00000X
Dermatology Physician
BP10033277
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01042245
RR MEDICARE
NV
Enumeration date
06/04/2010
Last updated
06/13/2013
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